Healthcare Provider Details

I. General information

NPI: 1871617134
Provider Name (Legal Business Name): LAURA JILL FERRELL PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/19/2007
Last Update Date: 02/28/2026
Certification Date: 02/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2741 INDIAN SCHOOL RD NE
ALBUQUERQUE NM
87106-2653
US

IV. Provider business mailing address

2741 INDIAN SCHOOL RD NE
ALBUQUERQUE NM
87106-2653
US

V. Phone/Fax

Practice location:
  • Phone: 505-507-2449
  • Fax: 505-255-7890
Mailing address:
  • Phone: 505-507-2449
  • Fax: 505-255-7890

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY704
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: